What is the efficacy of bosentan for the treatment of pulmonary arterial hypertension (PAH)?

Updated: Apr 25, 2018
  • Author: Kristin E Schwab, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Bosentan is an orally active dual (EtA/EtB) endothelin-receptor antagonist used to treat PAH. [51, 52, 53, 54] It inhibits vessel constriction and elevation of blood pressure by competitively binding to EtA and EtB receptors in endothelium and vascular smooth muscle. This leads to a significant increase in cardiac index associated with significant reductions in pulmonary arterial pressure, pulmonary vascular resistance, and mean right atrial pressure. The efficacy of oral bosentan in patients with PAH has been evaluated in multiple randomized controlled trials, including the BREATHE trials. It has been found to increase 6MWD as well as cardiac index, right ventricular systolic function, and left ventricular function. Reduced clinical worsening (defined as death, lung transplantation, or hospitalization for PAH) has also been reported. Because of its teratogenic potential, bosentan can be prescribed only through the Tracleer Access Program (phone: 1-866-228-3546).Ten percent of patients may have liver function test (LFT) abnormalities with use of the drug, thus monthly LFT monitoring is recommended. [19]

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